Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure

Have you ever been caring for a patient with a GI bleed and you wonder to yourself, "Is this bleeding ever going to stop!?" You keep replacing and replacing the patient's blood, but despite all of your interventions, the bleeding continues. What is the next step? Usually an esophagogastroduodenoscopy (EGD) will be performed to find the source of the bleed. In some cases, the gastroenterologist will recommend that the patient has a transjugular intrahepatic portosystemic shunt (TIPS) procedure performed. 

How Does It Work?

“Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure. This relieves the pressure of blood flowing through the diseased liver and can help stop bleeding and fluid back up.”
— Medline Plus

Why Have A TIPS Procedure Performed?

This procedure is most commonly performed (at least in my experience) on patients who have severe cirrhosis. Their liver is full of scarring which causes the blood within the veins of the esophagus to not drain through the venous system appropriately. The vessel walls start to balloon out (because of the pooling blood and extra pressure) causing esophageal varices. The shunt placed essentially bypasses the cirrhotic liver and relieves this pressure. This decreases the chance of the varice opening and causing massive blood loss. This does not fix the underlying liver disease; it simply buys the patient some additional time.

Multiple esophageal varices with bands placed on them to stop esophageal bleeding.

Multiple esophageal varices with bands placed on them to stop esophageal bleeding.